Background: Early pregnancy loss is very common and, in most cases, it can be considered as nature’s method to select for a genetically normal offspring. Threatened abortion is a relatively common complication during pregnancy, occurring in approximately 20% of all pregnancies. Maternal age, Outcome of previous pregnancies, health of mother, any infection etc can be decisive factors in the risk of pregnancy loss. Methods: The present study was a cross sectional study where patients admitted with threatened abortion were interviewed using pretested semi-structured questionnaire after the treatment. Outcome of pregnancy was recorded. Their basic socio-demographic data along with possible risk factors were recorded. TORCH Ig M and Ig G were done in all patients. Results: Out of 95 patients admitted with threatened abortion, 42 (44%) patients undergone abortion whereas in 53 (56%) patients, pregnancy was continued. Out of total 60 patients admitted with the complain of only vaginal spotting, in 39 pregnancy continued and in 21 patients pregnancy was aborted. (p-value<0.05). 50.52% were from age group of 21 to 25 years of age. It was also seen that after 35 years of age, significant number of patients aborted. Out of these 11 patients with high BMI, pregnancy was continued only one patient. Out of total 20 patients positive for IgM of toxoplasma infection, pregnancy was aborted in 13 (65%) patients. Out of total 15 patients positive for IgM of cytomegalo virus infection, pregnancy was continued in 11 (73.3%) patients. Conclusions: Patients of threatened abortion with only symptom of spotting per vagina have good chances of continuation of the pregnancy. Increased maternal age above 35, Overweight and bad obstetric history are also associated with pregnancy loss. Though there was no statistically significant difference it was evident that among all TORCH infections, IgM toxoplasma and Rubella are associated more with pregnancy loss.

INTRODUCTION children. By extrapolating this trend toward the time of

conception, it can be argued that most pregnancy lossesEarly pregnancy loss is very common and, in most cases, occur at a preclinical stage and that most of them are dueit can be considered as nature’s method to select for a to a genetic abnormality.3genetically normal offspring. In fact, it has been acceptedthat at least 50% of clinical abortions result from First trimester abortion is the pregnancy loss in firstchromosomal abnormalities.1,2 The incidence of fetal trimester of pregnancy, before 12 weeks of gestation.chromosomal abnormalities is gradually decreasing with Threatened abortion is a relatively common complicationduration of pregnancy to less than 1% among live-born during pregnancy, occurring in approximately 20% of all

November 2018 · Volume 7 · Issue 11 Page 4598

pregnancies.4,5 Vaginal bleeding during the first trimester Confidentiality of data was maintained at all level of theis associated with an approximate 5.5%-42.7% risk for study.subsequent complete miscarriage.6,7 Once patient was stable from their complains and allMany authors have observed an increasing risk of fetal emergency treatment given, they were interviewed usingdeath, in particular spontaneous abortion, with increasing pre tested semi-structured questionnaire. All necessarymaternal age.8,9 The association of age of the mother and treatment and intervention done with full asepticthe increased likelihood of chromosomal abnormalities is precautions. Outcome of pregnancy was recorded. Theirmanifested by the age-related increase of trisomy 21 and basic socio-demographic data along with possible riskcytogenetic studies on pre-implantation embryos.10 factors were recorded in questionnaire. TORCH Ig M andOutcome of previous pregnancies is another decisive Ig G were done in all patients.factor in the risk of pregnancy loss. For young womenwho have never experienced a loss, the rate of a clinical Statistical analysismiscarriage is as low as 5%.11 The risk increases toapproximately 30% for women with three or more losses All data was verified and entered in Microsoft Excel.but with a previous live-born infant and up to 50% for Data cleaning was done meticulously. Data werewomen without a live-born infant.12,13 It is estimated that analysed using SPSS version 20.approximately 33% of women with so called recurrentmiscarriage will have had three consecutive sporadic RESULTSmiscarriages by chance.14 High BMI, Anaemia, TORCHinfection etc can also be contributing factors for There were total 95 patients suggestive the symptom ofpregnancy loss. threatened abortion was admitted. Out of these patients, 42 (44%) patients aborted spontaneously whereas in 53The present study was aimed to study the effect of (56%) patients, pregnancy was continued.maternal risk factors on outcome of threatened abortionamong the pregnant women admitted with symptoms Table 1: Symptoms and outcome ofsuggestive of abortion during first trimester of pregnancy. threatened abortion.

• Thus, pregnant women with the complain of one or Table 1 shows symptom wise distribution of study more of the symptoms of abortion like spotting, participants. Out of total 95 patients, 60 (63.15%) bleeding, passage of fleshy mass, abdominal pain patients were admitted with complain of per vaginal and passage of grape like substance in first trimester spotting and 34 (35.78%) patients admitted with per of pregnancy were evaluated and patients diagnosed vaginal bleeding. with threatened abortion were included in the study.• Thus, study participants were patients diagnosed Out of total 60 patients admitted with the complain of with threatened abortion and willing to give only vaginal spotting, in 39 pregnancy continued and in informed written consent. 21 patients pregnancy was aborted. This difference was statistically significant (p-value<0.05). Table also showsDue permission was obtained from Ethical Committee of comparison of symptoms among patients in whomthe institute and also from the hospital to conduct the pregnancy continued and patients in whom pregnancystudy. All patients fulfilling the inclusion criteria were aborted.included in the study. All patients were explainedregarding nature and type of study and after that informed It was seen that out of total 53 patients in whichwritten consent was taken. pregnancy continued, 39 (73.58%) patients were having complain of spotting whereas only 14 (26.41%) patientsExclusion criteria were having complain of bleeding.• If patients not agree to give written consent, they Similarly, out of total 42 patients of abortion, 21 (50%) were excluded from the study without affecting patients were having complain of spotting whereas 20 course of treatment. (47.62%) patients were having complain of bleeding.

Table 2 shows various maternal factors associated with was not statistically significant (p-value >0.05). It wasabortion. Out of total 95 patients of threatened abortion, observed that as the gravidity increases, number of48 (50.52%) were from age group of 21 to 25 years of patients with continuation of pregnancy was alsoage. It was also seen that up to 35 years of age, number of increased. Previous abortion was also having effect onpatients of abortion decreases with age and after 35 years outcome of threatened abortion. It was evident thatof age, number of patients with abortion were more. number of patients with abortion increased as the duration of bleeding increased. Though these differencesThough, this difference was not statistically significant. were not statistically significant (p-value >0.05).Most of the patients were from normal BMI. There were6 overweight patients and 5 obese patients. Out of these Table 3: IgM antibody and outcome of threatened11 patients, pregnancy was continued only one patient. abortion (multiple responses).There were 35 patients with gestational age of 10-12weeks, 17 patients continued their pregnancy and 18 IgM Pregnancy Pregnancy Totalpatients aborted spontaneously. infection continued (%) aborted (%) Toxoplasma 7 (35.0) 13 (65.0) 20Out of total 95 patients, 44 patients were first gravida, CMV 11 (73.33) 4 (26.67) 15and out of these 44 patients, pregnancy was continued in Rubella 3 (33.33) 6 (66.67) 924 patients and aborted in 20 patients. This difference HSV 3 (60.0) 2 (40.0) 5

Table 3 shows individual TORCH IgM antibody and its may be an early sign of miscarriage although fortunatelyassociation with outcome of pregnancy among patients this may amount to no more than a threatenedwith threatened abortion. Out of total 20 patients positive miscarriage and the pregnancy continues, suggestingfor IgM of Toxoplasma infection, pregnancy was aborted favorable prognosis of minimal bleeding that is spottingin 13 (65%) patients. Out of total 15 patients positive for on continuation of pregnancy similar to present study. 16IgM of Cytomegalo virus infection, pregnancy wascontinued in 11 (73.3%) patients. Among IgM positive Age and success of previous pregnancies are twocases Rubella showed worst prognosis with 67% abortion independent risk factors that affect the loss rate. presentrate followed by toxoplasmosis (65%). study showed that up to 35 years of age, number of patients of abortion decreases with age and after 35 years Table 4: IgG antibody and outcome of threatened of age, number of patients with abortion were more. abortion (multiple responses). Though, this difference was not statistically significant. Similar finding was observed by Evrenos et al and Lykke IgG Pregnancy Pregnancy Total JA et al in different studies.17,18 The association of age of infection continued (%) aborted (%) the mother and the increased likelihood of chromosomal Toxoplasma 12 (75.0) 4 (25.0) 16 abnormalities is manifested by the age-related increase of Rubella 9 (45.0) 11 (55.0) 20 trisomy 21 and cytogenetic studies on pre-implantation CMV 25 (54.35) 21 (45.65) 46 embryos. HSV 10 (83.33) 2 (16.67) 12 In present study out of total 11 over weight and obeseTable 4 shows individual TORCH IgG antibody and its patients, pregnancy was continued only one patient.association with outcome of pregnancy among patients When maternal Body Mass Index was correlated withwith threatened abortion. Out of total 16 patients positive outcome of pregnancy, it was found that incidence offor IgG of Toxoplasma infection, pregnancy was abortion was 38% in patients with normal BMI. But itcontinued in 12 (75%) patients. Out of total 12 patients went on increasing to 83% in overweight and 100% inpositive for IgG of Herpes Simplex Virus infection, obese patients with increase in BMI. present studypregnancy was continued in 10 (83.3%) patients. suggests significant correlation between BMI andWhereas, out of total 20 patients positive for IgG of outcome of pregnancy (p:0.0009), increased chances ofRubella infection, pregnancy was aborted in 11 (55.0%) abortion when BMI is more than normal (overweight,patients. obese). As the BMI increased, incidence of abortion increased. This shows positive correlation of BMI withDISCUSSION pregnancy loss.

In present study, outcome of total 95 patients threatened It was observed that as the gravidity increases, number ofabortion were correlated with different factors to study patients with continuation of pregnancy was alsotheir impact on pregnancy. Out of total 95 patients, 42 increased, suggesting successful outcome of previous(44%) patients aborted whereas in 53 (56%) patients, pregnancy has positive correlation wth pregnancypregnancy was continued. The present study shows that outcome. On the contrary, Previous pregnancy loss hasbleeding amount and duration are positively related with adverse effect on outcome of threatened abortion. Thepoor fetal outcome. purported causes of recurrent miscarriage are multiple, ranging from genetic, environmental, infectious,In present study, the presence of passage of clot and metabolic, and endocrine to purely anatomic ones. Thepassage of fleshy mass suggest increased chances of best-defined causes are parental chromosomalabortion (p:0.02). Also, when spotting group compared abnormalities, metabolic abnormalities, and anatomicwith Bleeding group, there was statistically significant abnormalities. It was also seen that number of patients(p:0.0010) association found between symptoms and with abortion increased as the duration of bleedingoutcome, suggesting increased chance of pregnancy increased. Though these differences were not statisticallycontinuation with spotting PV. Gracia CR et al also found significant (p-value >0.05). Similar findings were alsothat the most common symptom of a miscarriage is noted by Hossain R et al. and Hackney DN et al.19,20bleeding. Of women who seek clinical treatment for Thus, in threatened miscarriage group, these werebleeding during pregnancy, about half will go on to have important for examinations during prenatal care.a miscarriage. Heavy bleeding is most strongly associatedwith miscarriage which is matching with present study. When active TORCH infection correlated with outcomeSymptoms other than bleeding are not statistically related of threatened abortion, Rubella showed poor prognosisto miscarriage. Complaint of pain in abdomen is (66% abortion rate) followed by toxoplasmosis showingnegatively associated with miscarriage.15 65% abortion rate. Comparatively CMV and HSV infection had better outcome with respectively 73 and 60Also, Viniker DA et al found that the first miscarriage % pregnancy continuation rate. Sebastian D et alsymptom is vaginal bleeding, which can range from observed that toxoplasma IgM in 50.7% of thespotting to being heavier than a period. A little spotting miscarriage cases and this is significant, compared to its